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首页> 外文期刊>The journal of trauma and acute care surgery >Defining the percentage of intra-abdominal hemorrhage in abdominal computerized tomography using stereology in patients with blunt liver injury and determining its relationship with outcomes
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Defining the percentage of intra-abdominal hemorrhage in abdominal computerized tomography using stereology in patients with blunt liver injury and determining its relationship with outcomes

机译：使用体视学定义钝性肝损伤患者腹部计算机断层扫描中腹腔内出血的百分比，并确定其与预后的关系

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BACKGROUND: The aim of this study is to determine the percentage of intra-abdominal hemorrhage (PIAH) on computerized tomographic (CT) scan via the Cavalieri method and to define whether this is correlated with the outcome. METHODS: Fifty-one patients (24 children and 27 adults) with blunt hepatic injury were studied in this Level III prognostic clinical cohort study. The stereologic method of point counting based on the Cavalieri approach was adapted to CT data so as to assess IAH and abdominal volume. PIAH was calculated as intra-abdominal fluid volume/whole abdominal volume × 100. RESULTS: Mean PIAHs in children and adults were 4.20% ± 2.85% and 6.28% ± 5.21%, respectively. Coexisting intra-abdominal injuries in children and in adults were as follows: splenic injury (29.2, 11.1%; p = 0.012), kidney (25, 11.1%), bladder (4.2, 14.8%), and pelvic fracture (12.5, 11.1%). PIAH was moderately negatively associated with hemoglobin levels (r = -0.301; p = 0.032), hematocrit levels (r = -0.322; p = 0.021), and GCS (Glasgow Coma Scale) score (r = -0.276; p = 0.05). Neither receiver operating characteristic curve analyses for PIAH nor outcomes were statistically significant in children. In adults, sensitivity and specificity of PIAH in predicting the prognoses when the cutoff levels were taken as 5.39%, 9.9%, and 12.4%, respectively, were as follows: operation (71, 84%), mortality (36, 93%), and intensive care unit admission (25, 94%). CONCLUSION: In patients with blunt hepatic injury, the Cavalieri principle of stereology can easily be added to the CT slices to calculate PIAH. This method is repeatable in other institutions and can be used as a guide to predict outcomes. It is suitable for a universal parameter to measure intra-abdominal fluid in blunt injury. PIAH has low sensitivity but high specificity to predict intensive care unit admission and mortality in cases of blunt hepatic injury in adults. Its specificity in predicting the need for operation is better than that of the anatomic liver injury grading systems in computerized tomography. LEVEL OF EVIDENCE: Prognostic study, level III.
机译：背景：这项研究的目的是确定通过计算机断层扫描（CT）扫描通过Cavalieri方法的腹腔内出血（PIAH）的百分比，并确定其是否与预后相关。方法：在该III级预后临床队列研究中研究了51例钝性肝损伤患者（24名儿童和27名成人）。基于Cavalieri方法的立体点算方法适用于CT数据，以评估IAH和腹部容积。 PIAH的计算方法为腹腔积液/整个腹腔体积×100。结果：儿童和成人的平均PIAH分别为4.20％±2.85％和6.28％±5.21％。儿童和成人并存的腹腔内损伤如下：脾损伤（29.2，11.1％; p = 0.012），肾脏（25，11.1％），膀胱（4.2，14.8％），骨盆骨折（12.5，11.1） ％）。 PIAH与血红蛋白水平（r = -0.301; p = 0.032），血细胞比容水平（r = -0.322; p = 0.021）和GCS（格拉斯哥昏迷量表）得分呈中等程度的负相关（r = -0.276; p = 0.05） 。对于儿童，PIAH的接受者操作特征曲线分析和结局均无统计学意义。在成年人中，PIAH在预测临界水平时的敏感性和特异性分别为5.39％，9.9％和12.4％，如下：手术（71，84％），死亡率（36，93％） ，以及重症监护病房（25，94％）。结论：对于钝性肝损伤患者，Cavalieri立体学原理可轻松添加到CT切片中以计算PIAH。该方法可在其他机构中重复使用，并可作为预测结果的指南。它适合作为通用参数来测量钝性损伤中的腹腔内液体。 PIAH的敏感性低，但特异性高，可以预测成人钝性肝损伤患者的重症监护病房住院率和死亡率。它在预测手术需求方面的特异性优于计算机断层扫描中解剖肝脏损伤分级系统的特异性。证据级别：预后研究，III级。

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